Eli's Rehab Report

Published on Thu Feb 28, 2008 PDF

CPT 2008 releases telephone and online codes -- and rehab providers can bill them

It may be a while before rehab care providers spend a lot of their skilled time with patients on the phone or via e-mail, but CPT 2008 is prepared just in case. Enter new "Non-Face-to-Face Nonphysician Services," which includes both "Telephone Services" and "On-line Medical Evaluation."

Say Hello to Telephone Codes

The telephone codes, 98966 (Telephone assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion), 98967 (...11-20 minutes of medical discussion) and 98968 (...21-30 minutes of medical discussion), have some strict guidelines.

The rules: The code descriptors themselves explain that you can't report these codes if the phone conversation results in a follow-up visit within the next 24 hours. And you can't report the codes if the conversation refers to an assessment you did within the last seven days. So what does that leave you with?

CPT Changes 2008 -- An Insider's View offers an example. A patient with a history of ACL reconstruction of the left knee calls his PT with a complaint of increased discomfort and edema after performing his home exercise program. In a 10-minute call, the PT listens to the patient's complaints, asks the patient questions, then determines that the patient wasn't doing the home exercise program properly. With these findings, the PT makes appropriate recommendations and instructs the patient to keep his next scheduled appointment (as opposed to coming in immediately for a checkup).

Because the call lasted 10 minutes, the therapist would report 98966.

Follow the Same Guidelines for New Online Codes

The online medical evaluation code guidelines are similar to the telephone codes, and the descriptor is pretty self-explanatory: 98969 (Online assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, guardian, or healthcare provider not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network).

So again, watch the timeframe from when you've last seen the patient and when you're seeing the patient next.

Moneymakers? As was the fate of the new medical team conference codes discussed in the last issue of Physical Medicine & Rehab Coding Alert, neither the telephone nor the online codes are covered by CMS, according to the 2008 Physician Fee Schedule. But this is a slightly different scenario from the medical team conference codes.

"CMS says that the telephone and online codes are noncovered -- which is different from being bundled into other codes," which was the case for the medical team conference codes, says Rick Gawenda, PT, director of PM&R at Detroit Receiving Hospital and owner of Gawenda Seminars. "If something is noncovered, you can actually bill the patient for these services."

That means you may want to have an Advance Beneficiary Notice handy when you see the patient in the office, in the event that he decides to call, Gawenda says.

Good idea: Check with your workers' comp and auto insurance policies, as well as other private payers, in case they cover the new codes, Gawenda said in the Eli-sponsored audioconference, 2008 Physical Medicine & Rehab Coding & Documentation Update. (To purchase a CD of this session, go to http://www.audioeducator.com/industry_conference.php?id=547, or to sign up for a live encore, go to http://www.audioeducator.com/industry_specialty.php?s=38.